Acne rosacea

Question 1

What is acne rosacea?

Answer 1

Common skin condition characterised by facial flushing that may be triggered by a number of factors e.g. alcohol, stress.

Question 2

Aetiology of acne rosacea?

Answer 2

Most commonly affects middle-aged women, particularly those with a fair complexion.

Question 3

Pathophysiology of acne rosacea?

Answer 3

Not entirely understood; involves chronic inflammation of the skin and is especially associated with triggers that increase body temperature.

• Believed both genetic and environmental factors contribute to the disease.

Question 4

Clinical features of acne rosacea?

Answer 4

Recurrent facial flushing

• Visible blood vessels
• May occur long before the onset of the rash
• Can be triggered by sunlight, alcohol, hot drinks, stress and spicy food.

Question 5

Rash features in acne rosacea?

Answer 5

Erythema with papules and pustules seen on the nose, chin, cheeks and forehead with sparing of naso-labial folds.

Question 6

Features of rhinophymatous rosacea?

Answer 6

More common in men

This subtype leads to a swollen, bulbous nose with enlarged sebaceous glands and prominent hair follicles.

The skin becomes erythematous, thickened, scarred and exhibits a rough, waxy surface.

Question 7

Investigations for acne rosacea?

Answer 7

Clinical diagnosis

When necessary, a skin biopsy can be used to rule out other differential diagnoses e.g. seborrheic dermatitis, acne vulgaris, SLE.

Question 8

General management of acne rosacea?

Answer 8

Avoid triggers

Camouflage creams

Sun protection

Using soap substitutes/emollients.

Question 9

Medical management of acne rosacea?

Answer 9

If there is persistent erythema, consider topical bromonidine 0.5% gel,

If there is mild-to-moderate papules and/or pustules, prescribe topical ivermectin.

Systemic retinoids may be used if topical measures fail.

Question 10

Complications of acne rosacea?

Answer 10

Thickening of skin - rhinophyma

Telangectasia